Shoulder pain is one of the most common presentations in a chiropractic office. This malady is responsible for nearly 5 million physician visits each year. Contrary to public opinion, there is no rotator cuff fairy that randomly taps a patient on the shoulder with lasting gifts of dysfunction and pain. Years of repetitive strain, sports, traumas, and poor posture are the primary contributors to shoulder dysfunction. Rotator cuff problems almost always begin with scapular dyskinesis, then anterior impingement syndrome, and eventually progress to rotator cuff syndrome if the causative factors are not corrected. This degenerative cascade affects the shoulder in a very predictable pattern. The only variable is the date at which the patient develops symptoms. Luckily there is ONE critical contributor that all chiropractors can address in the treatment of shoulder pain.
Yamamoto et al. (2015) studied a cohort of 525 participants without shoulder pain. Then, using ultrasound, his team identified those patients with asymptomatic rotator cuff tears; 24.5% showed a tear in one shoulder, and 11.9% had tears in both. (1) Yamamoto then subdivided this population into four groups based on their postural classifications as defined by Kendall.
(2) The researchers correlated each posture to the likelihood of rotator cuff tear and found that postural abnormalities are an independent predictor of rotator cuff tears.
“Prevalence of rotator cuff tears was 2.9% with ideal alignment, 65.8% with kyphotic-lordotic posture, 54.3% with flat-back posture, and 48.9% with sway-back posture. Logistic regression analysis identified increased age, abnormal posture, and past pain as factors associated with rotator cuff tears. It is difficult to conclude whether postural change represents a primary or secondary phenomenon due to rotator cuff tear. However, patients with ideal posture experience rotator cuff tears relatively rarely, so keeping the spine in ideal alignment would appear helpful as a measure for preventing rotator cuff tears as well as in rehabilitation therapy for shoulder disorders.” (1)
Based on our understanding of scapular mechanics and upper crossed syndrome, it is logical to conclude that posture is a risk factor for developing rotator cuff tears. This paper demonstrates the importance of correcting posture in four steps: